Muz M. Complex methods for surgical treatment of leg venous ulcers in patients with chronic venous insufficiency

This research is focused on processes of leg venous ulcers in chronic venous insufficiency (CVI), treatment of patients with this pathology including surgical methods and medications. The causes of venous leg ulcers developing in CVI are disorders of regional hemodynamics, reduced capillary density of the skin, especially in the elderly. The study involved 132 patients with chronic venous insufficiency. Patients with CVI were distributed into groups according to the CEAP classification (1994). Delayed or absent treatment causes 60-70 % of venous ulcers in people who suffer from CVI thus their treatment is actual medical and social problems. Treatment of patients with venous insufficiency at the stage of С6 (severe disorders of regional hemodynamics) was performed according to the Ukranian consensus. Treatment of 132 patients with CVI included surgery for superficial venous vessels of the lower extremities, permitted to eliminate pathological reflux, contributing the healing process of TU in these patients and reduced the duration of their recovery. The TU area in patients was decreased by 44.85 ± 1.94 %. Complete healing of ulcers was found in 26.78 % of patients after 5 weeks, and in 41.07 % - after 12 weeks. Recurrence of disease was only observed in 7 (12.5 %) patients between 1-3 years after the operation. As a result of treatment using low-molecular heparin the healing process of trophic ulcers was improved, accelerating their epithelization that was observed in 75% of patients in the main group and in 46 % of patients in the control group. The local use of calcium containing and biostimulating remedies helps to clean the ulcer surface from necrotic purulent secretions in skin autodermoplasty and engraftment of skin flaps in 80 % of patients. Application of autodermoplasty helps to reduce the overall duration of treatment by 3 times, autograft engraftment was achieved in 91.67 % of patients, thereby improving the quality of patient life promoting their rapid physical and social rehabilitation. The use of sсlerotherapy helps to achieve complete healing of trophic ulcers in 81.9 % of patients in term of 6 months, and in 100 % of patients after 12 months. Neurotomy in patients with trophic ulcers can reduce pain by 4 times, and muscle-fascial spasm and prevent the development of venous disorders. Its use can reduce the period of hospitalization and disability by 40-50 %, the frequency of relapses and the development of postoperative complications. In this image such pathogenetic methods and medications including the use of low-molecular heparin, biostimulating and calcium containing drugs; methods of intraoperative sclerotherapy, neurotomy of tibial nerves, and autodermoplasty were developed and introduced by us for rational tactics of treating patients with venous ulcers of low extremities. The efficiency of patient treatment with this pathology is increased by the suggested methods that decrease the duration of patient stay in hospitals and economic costs for their treatment, contributing the rapid recovery and patients return to everyday life.